Healing the Medical System
I make a very sharp distinction between Complementary and Alternative Medicine (CAM), and Integrative Medicine. In no way are they synonymous. I see CAM as being one piece of the picture. If all this movement accomplishes is to get doctors to sometimes prescribe herbs in addition to or in place of pharmaceutical drugs I think that would be a very limited accomplishment given what's possible at the moment.
What's possible is a great deal. You're probably not seeing it in Canada to the extent we are in the U.S. but our health system is on the verge of total collapse. I predict yours will be sooner or later, because this is in the nature of medicine, as we've set it up. What's happening in the U.S. is beginning to happen all over the world.
The roots of it are complex. Some of it has to do with the nature of medicine and how we've become so dependent on technology, which is inherently expensive. We are no longer trained in the inexpensive, low-tech methods of intervention.
One reason for the crisis has to do with the very success of modern scientific medicine. If you were an internist in the early part of the 20th century, most of what you'd be dealing with was acute infectious illness, which by nature is easier to deal with. We have rolled back acute infectious illness, at least for the time being, through attention to public health, immunization and effective therapies like antibiotics.
What we've been left with are chronic degenerative illnesses, which are by nature much more stubborn, difficult to deal with, time consuming, resistant to change and expensive to alter.
In addition, as a result of our successes, we have an aging population. Population experts tell us that what they call the "coming demographic bulge" of old people as the baby boomers begin to reach old age is unprecedented in world history. As you know the highest health care costs are incurred in the latter years of life, so we haven't seen anything yet. The strain on our resources that we're seeing now is just the beginning of something that is going to sink the system.
I can't exaggerate how grim the crisis in the US is at the moment. A significant number of hospitals are going bankrupt. That trend is accelerating. This includes large academic medical centres. The response in America has been a corporate take-over of medicine by people whose only interest is in getting what profit they can out of a sinking system. So the whole medical system has become profit-driven, and that is making the lives of both doctors and patients miserable.
No one likes managed care. Everybody is unhappy with it. For the first time a large number of physicians are quitting the practice of medicine because it's become so unsatisfying. No one envisioned the extent to which doctors' autonomy would have blown up in smoke. The fact is that what's done in medicine today is what's reimbursed, so doctors have no independent judgement as to which treatments are best. It's what's going to be paid for.
No one is happy with the time restrictions on doctor/patient interactions, which have completely sabotaged the therapeutic relationship. Word has gotten out that medicine is no longer a desirable profession, and for the first time, applications to the medical schools have begun to drop precipitously.
Some of the enormous consumer search for an alternative practice is rooted in dissatisfaction with the nature of conventional medicine today. But, some surveys have shown that many people are using CAM not as much because of dissatisfaction with conventional medicine, but because they want to work with practitioners whose belief system are more congruent with theirs.
These include such ideas as believing the body is capable of healing itself, a respect for nature and a suspicion of things that are synthetic and artificial. People want to be looked at as more than just physical bodies. In many of these other systems attention is paid to the mental and emotional aspects of human beings, and to the fact that they're community members and more than just physical systems.
The combined economic effects of the collapse of the conventional system, combined with the huge consumer surge away from conventional medicine, adds up to overwhelming pressure on the conventional institutions. I think it's no accident that it's just in the past few years that academic medicine in the US has begun to take this whole movement seriously,
Now aside from the fact that CAM is only about modalities I think the terminology is important. I don't like the word 'Alternative Medicine'. It pushes people's buttons. It suggests 'hippie medicine'. The connotation is that it's a replacement for conventional medicine and that has certainly never been my aim. Conventional medicine does some things better than anyone that's out there. It's very important for both patients and doctors to know when and when not to use the system.
I think a great problem is that because of the nature of medical education physicians are only trained to use it, so we bring it out as the first line of intervention for everything when in fact it might be appropriate for only a minority of health conditions.
I also don't like the term 'Complementary Medicine' because it sound much too polite to me. It suggests that we're trying to keep conventional medicine as the centerpiece and then you have little garnishes around the edge of the plate. In fact when I look at what's being offered out there in the name of integrative or holistic medicine most of what I see is complementary medicine.
If you're a clinic facing bankruptcy in the US, it's very tempting to cater to this huge consumer demand. But since our medical schools are not producing people trained in how to do integration, where are you going to find people to do it? It's very easy to put a massage therapist on the staff of your clinic or to puff some lavender oil out in the air in the waiting room and call yourself holistic. That's very far from what I have in mind asking for the development of integrative medicine.
The chaos and crisis in American medicine is so acute that I think important leaders in academic medicine are willing for the first time to consider that something is fundamentally wrong with the system and only radical solutions are going to work. That includes the radical restructuring of medical education.
Integrative medicine is much more than CAM. We've been trying to get a working definition of integrative medicine, and we see it as having three big components. One is what I would call whole person medicine - that is looking at people as mental, emotional and spiritual entities and community members, as well as physical bodies.
I think it's as foolish to call mind/body medicine alternative as it is to call nutrition alternative. Yet it is remarkable that you will find medical academicians today still maintaining that there is no evidence base for mind/body medicine.
There are three decades of very good medical research, but often if you ask these people to look at that evidence base they'll say those studies are not good enough. You get the impression that no matter what you showed them they would say it's not good enough.
The problem is not the lack of evidence but that some people are not going to look at it. There is a prejudice which arises from the paradigm from which western science and medicine operate. In essence we operate from a materialistic paradigm which says if you observe a change in a physical system the cause has to be physical. So the idea of non-physical causation of physical changes doesn't compute in the current paradigm.
That's why we can't make sense of placebo responses or that we regard them as nuisances rather than seeing them for what they are, which is the meat of medicine. The placebo responses are pure healing responses from within. Instead of trying to rule them out we should be trying to make them happen more of the time. The best medicine is the maximum healing response with the minimum intervention. That's what you're trying to do.
All of the randomized control testing we do of pharmaceuticals and all of the regulation that we have in place has not kept a great many worthless and dangerous drugs off the market.
Secondly, to me the most interesting fact that's come out of almost five decades of randomized control testing is this: I recommend this to you as an exercise. Go to a medical library and pull out at random any journal in which the results of RCT's are reported. Look at the summary table in the back and you will always find one or two or three subjects in the control group who show all of the changes produced in the experimental group.
That means that any change we can produce in the human organism by a pharmacological intervention can be exactly mimicked in at least some people some of the time by purely mind-mediated mechanism. To me that is the most important single fact that comes out of the thousands and thousands of randomized control tested drugs. It suggests the incredible plastic power of mind/body and the potential influence of belief on physiology. We should be finding out how to take more advantage of that.
That all falls under the heading of what I call the art of medicine, which is impossible to do if you've got ten minutes to see a patient, even if you've been trained in how to do it, which we generally aren't. I think it has a lot to do with just the impact, the act of coming to a doctor is a powerful interaction of belief systems. The words that you choose to use with a patient carry powerful impact, powerful suggestions. In general we are not trained in that.
The people who I've found in my travels to be very well trained were shamans and I think there's a very great deal that medical doctors can learn from shamans on how to take projections of belief and reflect them back on patients in ways that increase the probability of activating a healing mechanism. This is just one piece under mind/body medicine which is just one piece in the sphere of whole person medicine which I see as being central to integrative medicine.
